Priscilla Lynch: Did you get your vaccine yet? The question we will be asking for months
Rachel O’Mahoney from at the roll-out of vaccinations at for staff of the Bon Secours Hospital Tralee Domnick Walsh
“Well, did you manage to get it yet?” is a question we are all going to be increasingly asked in the coming months about the Covid 19 vaccine.
Unfortunately, it’s not quite as easy as ‘vax and go’, as the Ryanair ad would like us to believe (much to the horror of which is still recommending against all non-essential travel).
While recent weeks have seen the extremely welcome launch of Ireland’s Covid 19 vaccination programme, demand will far outstrip supply for many months to come.
So how is the biggest mass vaccination programme in the history of the State being rolled out and when are you likely to be able to get vaccinated?
In December, the Government published the national Covid 19 vaccination strategy for access to vaccines, which lays out the order in which everyone in the country will be offered a vaccine free of charge.
At the top of the list is frontline healthcare workers, people over the age of 65 who are resident in long-term care, followed by those aged over 70 years.
However, since the publication of the priority list, there have been calls from various groups to speed up their access to the vaccine. There were suggestions that teachers and childcare workers should have earlier access to the vaccines, but this has been dismissed, while some aged under 65 years with serious medical conditions feel they should be entitled to quicker access than their current place on the list.
There is potential for some tweaking of groups further down the priority list in the coming weeks according to Government sources, but it will depend on supply and what the science says in relation to who is most at risk/would benefit most.
In line with most of the world, the biggest current challenge for our Covid 19 vaccination programme is supply.
Ireland signed up to the European Commission’s () Covid 19 vaccine arrangements, whereby we can access vaccines that have been granted conditional approval by the European Medicines Agency (). We have also been included in the advance purchase deals for over 2.3 billion doses.
Under this arrangement, participating countries are allocated Covid 19 vaccine supply equally according to their population size, thus we can access about 1.1% of the total pot which will be more than enough to vaccinate everyone who wants to be vaccinated, before the end of the year.
So when we hear negative comparisons of Ireland’s Covid 19 vaccination programme with countries like the , the US, and Israel who have already vaccinated far more people than we have, it should be noted that they have their own medicines regulatory authorities who have licensed Covid 19 vaccines ahead of the and have negotiated their own supply arrangements.
However, one thing we can learn from other countries that are ahead with Covid 19 vaccination is that we need to be able to rapidly and sustainably scale-up our vaccination capability when vaccine supply increases, which happens quite quickly when additional vaccines are licenced.
In late December, the licenced the Pfizer/Bioech m Covid 19 vaccine, followed by the Moderna vaccine in early January, and we are receiving supply of both of these currently.
Around 40,000 doses of the Pfizer/Bioech is being delivered weekly and smaller amounts of the Moderna vaccine, with the declining to provide any further delivery schedule when queried by the Irish Examiner.
There has been some criticism both nationally and internationally that the has been slower than other regulators in licensing the Covid 19 vaccines which have completed the necessary trials processes and didn’t purchase enough of the Pfizer/Bioech vaccine.
But it has since increased its order for this vaccine, started a review of the Johnson & Johnson Covid-19 vaccine candidate, and is expected to licence a third Covid-19 vaccine, the Oxford/ AstraZeneca vaccine, before the end of this month
This is seen as the ‘game-changer’ vaccine as it can be stored at regular fridge temperatures and is thus well suited for roll out in the community by s, general practice nurses, and pharmacists, and Ireland has ordered 3.3 million doses of it.
However, we won’t be getting advance deliveries of the Oxford/ AstraZeneca vaccine this month, before it is approved by the and , despite Minister for Health Stephen Donnelly’s statements to that effect.
Last Tuesday, the Dáil signed off on an agreement of €91 million for s and pharmacists to administer Covid 19 vaccines to approximately 1.5 million people, starting with the over-70s, with those in the oldest age groups to be invited for vaccination when supply allows, likely to commence sometime in February when stocks of the Astra/Zeneca vaccine arrive.
A number of mass Covid 19 vaccination centres are also in the process of being set up, the first three of which were used to vaccine a large number of s, practice nurses and other frontline staff last weekend, and these will open to the public on a priority list basis when our supply of Covid 19 vaccines increase.
Minister Donnelly said on Wednesday that everyone in the country will be offered a vaccine by September.
As of Wednesday night, 121,900 vaccines have been given to frontline healthcare workers, as well as residents and staff in nursing homes.
The latest figures show that 73,100 vaccinations have been given to frontline health workers and 48,800 to staff and residents of long-term care facilities.
This includes 3,900 people due to receive their second dose of vaccines this week.
This puts Ireland close to the top of the European league table currently in terms of the Covid 19 vaccination rate per head of population.
So we are catching up after a sluggish start – our first supplies of the Pfizer/Bioech vaccine arrived in the country on Stephen’s Day, December 26, but we only started vaccinating a very small number of people on the 29th of December, slowly increasing the numbers vaccinated, mostly frontline health staff initially.
Special vaccination teams were assembled to vaccinate residents in older care long-term facilities in early January with some criticism that the rollout in nursing homes should have commenced quicker given their risk profile and the fact that Covid 19 outbreaks in these settings have been rapidly increasing again since late December.
The vaccination plan for nursing homes has since been accelerated and all staff and residents should be fully vaccinated with two doses by mid-February, though nursing homes impacted by Covid 19 outbreaks will have some staff and residents who have to wait longer.
We’ve also reduced our ‘buffer’ supplies of second doses as confidence in the supply chain has increased, and the is also extending the dosing interval between getting the second dose by a week for the Pfizer/Bioech, so we are using up more of our stock as it comes in instead of letting it sit and wait, and are thus aiming to vaccinate between 40,000-50,000 people a week based on current supply.
There has been much media coverage of various Covid 19 vaccination coverage proclamations in the Dáil by the Taoiseach, Tánaiste and Minister for Health such as that 700,000 people in Ireland could be vaccinated by the end of March, 1.5 million could be vaccinated by June and the vast majority of the country vaccinated by September.
These are guesstimates and depend on the aforementioned licensing and supply agreements we are party to, which are fluid and open to change, such as the fact that Pfizer is reducing planned Covid-19 vaccine stock delivery temporarily while it upgrades its factories to increase production.
However, there is much to be hopeful about; on Tuesday, following increased pressure to accelerate Europe’s Covid-19 vaccination programmes, the said that by this summer member states should have vaccinated a minimum of 70% of the adult population, with increased orders for the Covid-19 vaccines already licenced.
Yes, but there have been some teething issues with our programme rollout, however, that need to be acknowledged and learned from.
Our lack of a national healthcare system, electronic healthcare record, and unique health identifiers for the entire population is making planning and tracking vaccination rates a challenge, with a lack of real-time data on the numbers vaccinated. Last week finally saw the ’s national online Covid-19 vaccination booking portal go live after a number of delays though it is currently just available to s and their staff to book their own vaccines. It is planned that the public can use this booking system as vaccine supply increases and we move through the priority list but will it be robust and accurate enough to keep up with the numbers that will need to use it in the coming months?
In addition, it emerged in recent days that some leftover Covid-19 vaccines were given to family members of staff in the Coombe and Rotunda maternity hospitals, and that construction workers in University Hospital Kerry also received ‘spare’ doses ahead of local community-based healthcare workers, with similar tales from some other hospitals and nursing homes.
This news raised caused understandable anger among some of the public, particularly people more vulnerable to Covid-19 who face waiting weeks or months before they can access the vaccine.
While acknowledging these cases should not have happened, the has pointed out that they occurred in the first 10 days of the vaccine rollout when it was originally believed that just five doses of the Pfizer/Bioech vaccine could be extracted from each vial but actually more doses than planned for were able to be reconstituted (it is now accepted that six doses can be extracted from each vial, and seven in some cases).
This vaccine in particular comes with significant logistical challenges, needing to be stored at -70C, and once thawed has to be used within five days of refrigeration, and once the vials are open the doses must be administered within six hours or dumped.
In addition, some frontline staff eligible for vaccination were unavailable due to having Covid 19 or having to isolate, etc, and clearly, no one wants any of these precious vaccines to go to waste.
The HSE has since issued guidance (January 12), on the sequencing of vaccinations of frontline healthcare staff and what to do if there are spare vaccines that might expire, which include establishing standby lists of frontline healthcare workers later in the sequence order who can be vaccinated at short notice.
There are still some questions to be answered around these cases, however, and also about why some hospitals and private healthcare facilities that are not treating or admitting Covid 19 patients have received vaccines for their frontline staff ahead of hospitals like Nenagh which have had to wait despite having a significant number of patients and staff affected by the virus, with pharmacists and dentists still awaiting dates for when they will be vaccinated despite also being key frontline healthcare workers.
There is also a lack of public clarity on who exactly is in overall charge of the national Covid 19 vaccination programme and responsible for making the key decisions.
Is it the Department of Health, Minister for Health, , , the National Immunisation Advisory Committee (), the special Covid 19 vaccine taskforce who signed off the priority lists, or the Cabinet?
In response to queries from the Examiner on this, the merely replied: “Vaccine allocation is a matter for the Department of Health. The HSE is responsible for operational matters such as purchase and rollout/implementation of the vaccine programme.”
Yes, there have been some teething issues with the rollout of the Covid 19 vaccination programme and more are inevitable but we are currently making good progress within the supply confines.
It is imperative that the rollout continues to proceed in a transparent and equitable way to try to avoid further inevitable attempts at queue jumping and to ensure public confidence and maximum uptake because we will need vaccine coverage of the majority of the population, at least 70% and probably higher, to achieve ‘herd immunity’.
Misinformation and vaccine hesitancy has negatively impacted previous vaccination programmes like the and ones, so public messaging around the Covid 19 vaccine programme needs to be clear, comprehensive, honest, and responsive so people know exactly what is happening with the rollout and when they can book their vaccines, to try to reduce the current misinformation and confusion among many of the public, and indeed some of our public representatives.
And while social distancing and other restrictions are likely to remain with us for some time to come, and there are growing calls for Ireland to adopt a ‘Zero Covid’ approach to reducing cases and to try to avoid further lockdowns, the Covid 19 vaccination programme is currently our best hope of life returning to some semblance of normality this year.
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is the Clinical Editor of the , Editor of and journals, and a regular contributor to national print and broadcast media on healthcare news. @priscillalynch (Twitter
